Health Organization for Pudendal Education

Please can i have some advice regarding the standard expectations & work up with nerve blocks - sorry to raise this old chestnut!

I had a nerve block 2 weeks ago & have been recalled at 4 months for the next one. I was under the impression that these were repeated every 6 - 8 weeks ??


I had a good initial response but little effect after 5 hours (is this positive for entrapment ?) I was told give it 2 weeks to see if the steroid works. So why wait 4 months until the next block ??

Here are my thoughts :
If a nerve is trapped then a steroid will not have any real effect
If a nerve is irritated then a steroid will certainly reduce inflammation & should give some relief.
If a nerve is trapped then untrap it early rather than cause any further damage.

happy to debate this & as always grateful for advice.

Charlie

I'm not sure that there is a standard in fact, rather that different physicians have different approaches. Of course those approaches should be directly related to the patients reaction to those blocks.
Any standard in PN diagnosis and treatment has been taken from The Nantes Criteria which would advocate the nerve block as a diagnostic tool. I would like to see some figures showing how many people have had lasting success from steroid nerve blocks. I don't think we have found many/any people on this forum so far. Anyone else?
I have heard of some people benefiting longer term from botox treatments, but I could only pontificate that they were not actually, mechanically entrapped.

Charlie123 wrote:If a nerve is trapped then a steroid will not have any real effect

Agreed it makes sense that if the nerve is entrapped a steroid injection is going to have no good lasting effect, hence the diagnostic application of nerve blocks.

Charlie123 wrote:If a nerve is irritated then a steroid will certainly reduce inflammation & should give some relief.

Agreed, as long as the the block hits the right spot and sometimes they don't.

Charlie123 wrote:If a nerve is trapped then untrap it early rather than cause any further damage.

Agreed, unless lifestyle changes, conservative treatments and medication can make enough positive changes. Surgical decompression is by no means foolproof.
However there do seem to be more positive outcomes the earlier the decompression.

Are you wondering if pursuing more blocks is really worth it ? I would be pondering the same question
Take care,
Helen

Charlie123 wrote: I had a good initial response but little effect after 5 hours (is this positive for entrapment ?) I was told give it 2 weeks to see if the steroid works. So why wait 4 months until the next block ??

Here is the Nantes take on nerve blocks:

Pain Relieved by Diagnostic Pudendal Nerve Block

Anesthetic infiltration of the pudendal nerve significantly
relieves pain for the duration of local anesthesia. This is an
essential criterion, but is not specific as it simply indicates
that the pain is situated in the territory of the pudendal
nerve; pain related to any perineal disease (e.g., anal) would
also be relieved by pudendal nerve block and other types of
nerve lesions would also have a positive diagnostic block
when they are situated distal to the site of infiltration. A
negative block does not formally exclude the diagnosis when
it is not performed with sufficient precision or when it is
performed too distally (e.g., in the pudendal canal, while the
pudendal nerve lesion may be situated at the ischial spine).
The infiltration technique (with or without CT guidance, with
or without neurostimulation) has only a minor impact on the
positive or negative response to nerve block.

So in your case it sounds like the marcaine in the block gave you some temporary relief. As I understand it, if the medication was delivered properly to the area of the pudendal nerve, since you had temporary relief that basically shows you have some type of pudendal nerve irritation at or distal to the site of infiltration of the medication. It doesn't prove you have an entrapment but it means that you might have one.

Here are my thoughts :
If a nerve is trapped then a steroid will not have any real effect
If a nerve is irritated then a steroid will certainly reduce inflammation & should give some relief.
If a nerve is trapped then untrap it early rather than cause any further damage.

I agree that if you have an entrapment a steroid isn't likely to relieve the entrapment. It might take down the inflammation temporarily but chances are the irritation will come back as the nerve continues to be irritated by whatever is entrapping it, such as scar tissue or tight ligaments, etc.

I'm not sure why the doc wants to wait 4 months for another block. Typically they are scheduled closer together. When deciding on whether to have more nerve blocks I think it's important to take into consideration that some people get worse long term from blocks. I can see why someone might want to have them if they are strongly contemplating the surgical route and the surgeon requires a series of 3. Or if they feel they just have nerve irritation and they experienced significant benefit from the first block it might make sense to try more blocks. Otherwise, I am not a huge fan of nerve blocks because I know of too many people who regret having them.

Sorry about the late reply,

thankyou helen & violet for your discussion. I certainly feel clearer about the issue of nerve blocks.

helen would you mind if i PMd you as i would like to pick your brain ?

x charlie

Pick away Charlie